Charles Rashan

METROPOLITAN
‘| POLICE

The Coroner, ME Hassell

Senior Coroner Deputy Assistant Commissioner
Inner North London
St Pancras Coroner's Court 6" Floor
Camley Street New Scotland Yard
London London
N1C 4PP SW1A 2JL
Your ref:

Our ref: ix/81/17

Date: 23% August 2018

Dear Ms. Hassell,

Re: Inquest touching the death of Rashan Charles
Response to Prevention of Future Deaths Report

| am the Deputy Assistant Commissioner for Professionalism in the Metropolitan Police
Service (MPS). | write in response to your Regulation 28 Report to Prevent Future Deaths
dated 29" June 2018. Your report was initially sent to Deputy Assistant Commissioner Matt
Twist following the conclusion of the inquest into the death of Mr Rashan Charles.

| note that the medical cause of Mr Charles’ death was recorded on 20" June 2018 as:
1a) cardiac arrest;

1b) upper airway obstruction by a foreign body during a period of restraint;

In your Report, you made raised the following matters of concern:

1. An apparent struggle to resist search or arrest, might in fact be a struggle to breathe,
or might become that;

2. Choking is not always accompanied by classic signs such as clutching the throat,
coughing, red face or bulging eyes, but can be silent and very quick;

3. It can be extremely difficult to assess whether breathing is present and normal,
particularly in a stressful and/or noisy situation. (I heard evidence that, for training
purposes, abnormal breathing could possibly in future be simulated by a virtual
reality programme.)

4. Members of the public can sometimes give vital assistance, but this assistance might
need to be managed.

You further stated that “analysis of a situation by a member of the public might give
helpful insight, but on the other hand might not be accurate.

Even a single member of the public might unwittingly distract an officer, especially in
a fast-paced environment.

| heard evidence that, at present, MPS training does not include specific advice
about how best to utilise members of the public who are willing and able to assist
police officers”.

In drafting our response we have consulted with the relevant subject matter experts: mz
MPS Medical Director, [EEE Strategic Health & Safety; Inspector J
Officer Safety and the College of Policing.

The College of Policing set the First Aid Learning programme (Appendix A) for police forces
of England and Wales. This has the approval of the National Police Chiefs Council (NPCC)
and the Health and Safety Executive (HSE).

Response to Matters of Concern

| respond to your Report as follows:

1. An apparent struggle to resist search or arrest, might in fact be a struggle to breathe,
or might become that.

The possibility that an apparent struggle or resistance might mask a medical
emergency is firmly established within the MPS’ Emergency Life Support (ELS)
training. It is central to training concerning positional asphyxia and Acute Behavioural
Disturbance. It has also informed the MPS’ review of guidelines associated with
restraint positions. Current work is focusing upon tilting the subject’s head forward to
help reduce the risk of concealed objects falling into the airway and causing choking.
The revised guidance is currently being peer-reviewed prior to adoption by the MPS.
The findings will be shared with the College of Policing to help ensure best practice
across England and Wales.

The careful assessment of a subject's breathing features in one of the training
scenarios within the 2018 / 2019 ELS training package. The scenario requires an
assessment of a subject’s breathing, and them being re-positioned to assist breathing.
The scenario then develops to noisy breathing and onto the delivery of
cardiopulmonary resuscitation (CPR).

2. Choking is not always accompanied by classic signs such as clutching the throat,
coughing, red face or bulging eyes, but can be silent and very quick.

The MPS ELS training is delivered in accordance with the College of Policing First Aid
Programme Specification (‘the Programme Specification’). This mandates the content

of the first aid programme and the frequency with which elements of the curriculum
should be delivered by police forces of England & Wales.

The Programme Specification states in respect of choking: “An airway obstruction can
be recognised by difficulty speaking, attempts to breathe or cough, increasing signs of
asphyxia (blueness discolouration to face) and eventual loss of consciousness.
Therefore, it is therefore made clear that individuals who are choking they may not be
able to breathe or cough.

Training on the signs and symptoms and the treatment of choking is included in the
initial training delivered to new recruits. It is then included in refresher training in a three
yearly cycle. It will next be covered in the 2019/ 2020 training cycle.

Where the subject is not showing any of these classic signs the fact that they are not
breathing, or are experiencing difficulty breathing should be identified by the breathing
check. This aspect of first aid training is covered below.

. It can be extremely difficult to assess whether breathing is present and normal,
particularly in a stressful and/or noisy situation.

The importance of completing a thorough breathing check and regularly monitoring a
subject’s breathing is central to ELS training. The training states that if breathing
cannot be established because a subject is in the recovery position, they should be
turned onto their back to facilitate a full breathing check. It further states that CPR
should be commenced if there is any doubt.

Under current training, when completing an initial assessment of a subject's breathing,
the check includes:

- Not breathing
- Not breathing normally, and
- Not sure.

The ELS training advises the following depending on the outcome of the breathing
check:

a. snoring may not be normal breathing, especially if drugs and alcohol are
involved i.e. it may be due to a partial ainway obstruction. When a subject
appears to be snoring, officers are to attempt to rouse them. If the snoring is
because the subject is asleep, they will rouse. If the subject is roused, their
snoring stops and they appear to be breathing normally, then their breathing
should continue be monitored.

b. If the subject is roused but the snoring continues their breathing should be
checked carefully.

c. If the subject does not respond, their airway should be opened. If they still do
not respond, are not breathing normally, or the first aider is unsure, then CPR
should be commenced.

4. Members of the public can sometimes give vital assistance, but this assistance might
need to be managed.

The potential value of bystanders in dealing with casualties is recognised within the
training given to officers and is explored with various scenarios. These include
assisting in placing a subject into the spinal recovery position, crash helmet removal
and the delivery of CPR.

However, due to the variety of potential situations combined with differences in their
background, training and skills, it is not possible to be prescriptive about how
bystanders may be best utilised. Instead, officers are expected make informed
decisions based on the continual assessment & review of the specific circumstances
of the incident through the application of the National Decision Model (Figure 1).

Joptions

MQencie q

Figure 1: College of Policing: National Decision Model

It is emphasised that bystanders should only be given tasks appropriate to any training or skills
they might have and that they cannot take responsibility for casualties unless they are medical
professionals with the training for such events.

Conclusion

The MPS has recommended changes to the Personal Safety Manual. Module 12,
‘Management of Persons Suspected of Concealing Items in Mouth’, now requires that where

4

possible the subject's head should be tilted forward thereby reducing the risk of any objects
falling into the airway and causing choking.

The MPS recognises the importance of effective first aid training to support its officers who
may be required to administer first aid.

First aid training of MPS officers is the remit of MPS Senior First Aid Advisor,
is also Chair of the National Police First Aid Forum. The MPS continues to have

a leading role in the-revigw and refinement of existing techniques and practices and
acknowledges that this remaing a continual learning process.

Yours sincerely,

Deputy Assistant Commissioner